Chemoprevention of colorectal cancer: feasibility in everyday practice?
Chemoprevention means the use of agents to prevent, delay, or reverse carcinogenesis. This review was designed to critically discuss the most promising agents in colorectal cancer (CRC) chemoprevention. Aspirin is the best studied chemopreventive agent for CRC. Optimal chemoprevention requires long-term use and high dose of aspirin that may increase the risk of gastrointestinal bleeding. Nonsteroidal anti-inflammatory drugs and selective cyclooxygenase-2 inhibitors may also be candidates for chemoprevention. The regular use of nonsteroidal anti-inflammatory drugs, however, causes adverse effects including gastrointestinal bleeding, and cyclooxygenase-2 inhibitors may increase the risk of cardiovascular events. In patients with ulcerative colitis 5-aminosalicylates reduce the risk of CRC and dysplasia. Ursodeoxycholic acid can reduce the risk of dysplasia or CRC in patients with primary sclerosing cholangitis and ulcerative colitis. Current data are insufficient to support the use of hormone replacement therapy to reduce the risk of CRC. Statins may have chemopreventive effects, but further investigation of their overall benefits in preventing CRC is warranted. Antioxidant supplements cannot prevent CRC. The usefulness of selenium, folate, calcium, and vitamin D awaits further evaluation. Chemoprevention cannot yet be accepted as standard medical practice. Use of chemopreventive agents cannot be a substitute for colorectal surveillance.
Herszényi
László
L
2nd Department of Medicine, Semmelweis University, Hungarian Academy of Science, Budapest, Hungary. hersz@bel2.sote.hu
Farinati
Fabio
F
Miheller
Pál
P
Tulassay
Zsolt
Z
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods*; D002986:Clinical Trials as Topic / Q000379:methods; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D019587:Dietary Supplements; D005194:Family Practice / Q000379:methods / Q000639:trends; D005240:Feasibility Studies; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D019804:Mesalamine / Q000627:therapeutic use; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000970:Antineoplastic Agents; D052246:Cyclooxygenase 2 Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019804:Mesalamine; D014580:Ursodeoxycholic Acid; D001241:Aspirin